Health insurance companies’ tendency to put profits before people received a hard-hitting blow in 2018. An Oklahoma jury awarded a $25.5 million verdict against managed health care company Aetna for denying coverage to a cancer patient.
Americans deserve the right to receive medical care based on a doctor’s recommendations, not health insurance company’s profits. When medical appeals don’t work, it’s time to seek legal counsel.
As reported by CNN, Aetna denied proton beam therapy in 2014 to 53-year-old Orrana Cunningham, who had stage 4 nasopharyngeal cancer near her brain stem. Doctors at MD Anderson Cancer Center in Houston said Orrana needed proton treatment because her tumor was so close to her brain, brain stem and optic nerve. Standard radiation treatment would likely cause debilitating side effects such as blindness, memory loss and potentially death.
Aetna disagreed, denying the proton beam therapy multiple times because it was considered investigational and experimental. Proton therapy is significantly more expensive than traditional radiation, but Aetna did not cite it as a reason for denying coverage.
Orrana’s husband, Ron Cunningham, took out a second mortgage on the couple’s home to pay for the $92,000 treatment. After more than 30 days of proton beam therapy over six weeks, the treatment appeared to work. Orrana went home but her brain swelled uncontrollably, causing her brain stem to herniate. Orrana did not survive.
Before her death, Orrana said she wanted Ron to stand up for her, for himself and for all the other victims of reckless insurers. She had filed the initial paperwork to sue Aetna. Ron continued the legal fight.
Aetna defended the case aggressively, bringing in powerful attorneys and medical experts. The trial revealed none of Aetna’s medical directors had even read the insurance contract before denying the claim. Furthermore, the Aetna doctors were medically unqualified to make a decision on the claim, had never heard of the duty of good faith, had never received any training on Aetna’s obligations to its policyholders under Oklahoma law and were severely overworked. One doctor claimed she worked 16-hour days and decided more than 80 claims per day. The doctors also received sizable bonuses each year, based on Aetna’s profits.
Additionally, it came to light that the medical directors spent less than 45 minutes reviewing Orrana’s 150-page claim.
The jury did not believe Aetna acted in good faith and decided the company caused emotional distress and compromised the health of its policyholder by denying coverage for proton beam therapy. One of the most compelling testimonies came from a doctor not involved with the case who said proton therapy is a well-established cancer treatment which has been used for decades.
After 12 days of trial, the jury found Aetna breached its contract with the Cunninghams. On top of awarding the Cunninghams the $92,000 paid out of pocket, the jury awarded an additional $15 million for emotional distress and gave Ron $500,000 individually. In the punitive damage phase of the trial, the jury awarded $10 million to punish Aetna for reckless conduct, bringing the total award to more than $25.5 million.
Cases like the Cunningham’s are becoming all too common. A recent study from the Washington, D.C.-based Doctor-Patient Rights Project suggests over 50 million insured Americans have been denied essential treatments, with two out of three denied multiple times.
Johnson and Biscone, P.A. is here to help. We know insurance companies fight hard to win bad faith cases, but we fight even harder. We know the law, and we have the expert witnesses needed to win jury trials.
If you or your loved one has been denied the treatment they need, contact us for a free consultation. We will dedicate the time it takes to learn your case’s history and get the verdict you deserve.
Bryce B. Johnson is a partner and personal injury lawyer at Johnson & Biscone, P.A.
